An outpatient or ASC setting can lead to a better experience for everyone involved, from the surgeons to the patients to the staff, according to one executive.
As more orthopedic procedures move off of the Inpatient Only List, surgery centers are becoming more important for boosting orthopedic practices’ efficiencies and outcomes.
David Fitzgerald, CEO of Albany, N.Y.-based OrthoNY, which operates three surgery centers in New York, recently connected with Becker’s to share the orthopedic trends he’s watching, how to successfully transition procedures to ASCs and why outpatient settings work.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are some of the big trends in the orthopedic and ASC space that you’re following today?
David Fitzgerald: There is definitely a movement of cases to the surgery center. It comes down to really two or three different things, but the biggest focus is the minimally invasive procedures. It’s also the ability to heal, the way we’re able to use anesthetics and people being more mobile following surgery, so that minimally invasive trend of getting cases to the surgery center is huge.
For us, the focus in 2024 was adding shoulder procedures to our centers. We had predicted that we could move about half of our total shoulder procedures into the surgery center. We were slightly less than 50% of our shoulder procedures in 2024 moving into the surgery center, but we were able to do a greater count than we thought we’d be able to do. That was because more and more people were eligible, and that comes down to really having the right surgeons. This year, around 70% of the total shoulders will be done in the surgery center.
Q: What is the process for moving a procedure that has historically been an inpatient surgery into an ASC?
DF: There is a patient side and a physician side of things. I’m going to set the patient aside and really focus only on the surgery center and the physician. The surgery center has to be prepped. We’ve had to have talked to the physician, had the right trays, understand the right way that they are doing the process and have them meet with the anesthesia team so that they know how long each case is going to be. The team has to be trained and the anesthesia side has to be coordinating with them.
On the flip side, you’ve got to be talking with the physician, and they’ve got to be excited about it. Physicians are always judged on one thing and one thing only, and that’s outcomes. Sometimes we may say that physicians are a little bit rigid in what they want to do, but they’re not. They’re saying that “I know how to predict what I’m going to do, so therefore I’m going to do it this way.” Doing it in the surgery center is a change for them, and so they have to be very comfortable with it. The physician has to have confidence that they’re going to have as good or better outcomes in the surgery center than they would in the hospital setting.
Q: How do physicians, patients and staff benefit from more procedures being performed in ASCs?
DF: It is just a better environment for everyone. Nobody’s sick ever in the building. It’s not necessarily a more relaxed space compared to the hospital, but because it’s a moving environment, and it’s moving a little bit more quickly, it’s not so formal. We don’t have a housekeeping group that comes in between each case and they come up to clean the room, which is much more formal. In the ASC, everybody pitches in and everybody does everything. They’re all talking, they’re all coordinating and they’re focused on one thing, which is patient care. It just is a better environment for the physician, for the patient and for our staff. It works 10 times better.
